Human Resources

Benefit Forms

2025 HCRA-DCRA Enrollment Form

2025 DCRA Plan Summary

2025 HCRA Plan Summary

2025 Health Rates Comparison Chart

Dental Plan Enrollment Form

Acknowledgement & Missed Premium AR Agreement

Additions and Deletions Worksheet

Affidavit of Marriage or Domestic Partnership

Affidavit of Parent-Child Relationship

Anthem Claim Form

CalPERS beneficiary designation

Computer Vision Care Form

DCRA / HCRA Reimbursement Form

Declaration of Health Coverage

Dental Claim Form

Domestic Partner Tax Dependent Certification Form

FlexCash Enrollment Form

FSA / ASIFlex debit card request

New Employee Benefits Enrollment Worksheet

Standard Insurance Co. Beneficiary form

VSP Premier Vision Enrollment Form

VSP Premier Vision Plan Enrollment

VSP Vision Reimbursement Form